冠状動静脈瘻を伴う巨大冠状動脈瘤術後に一過性左室機能低下をきたした1例

Transient Left Ventricular Dysfunction after Giant Coronary Aneurysm Resection and Repair of Coronary Arteriovenous Fistula with Coronary Artery Bypass Grafting：Report of a Case

はじめに　冠状動脈瘤はまれな疾患で，60 mmを超える巨大冠状動脈瘤に対する手術報告は限られている．われわれは，左冠状動静脈瘻を伴った巨大冠状動脈瘤に対して瘤切除および冠状動脈バイパス術（CABG）を行い，術後に想定外の心機能低下をきたした症例を経験したので報告する．

Coronary artery aneurysm with coronary arteriovenous fistula is a relatively rare clinical setting. We report a surgical case of a 69-year-old male with a giant coronary artery aneurysm, finding coronary arteriovenous fistula on computed tomography （CT）. We performed complete aneurysm excision and coronary artery bypass grafting with the left internal thoracic artery to the posterolateral branch. The fistula was located between the giant aneurysm on the circumflex artery and the coronary vein close to the coronary sinus, closed with aneurysm sac. The postoperative CT found no residual aneurysm and fistula. However, the great cardiac vein was thrombosed, and the impeded venous flow by the thrombus seemed to reduce the left ventricular ejection fraction （LVEF）. Four months after the operation, the LVEF improved to the preoperative level.